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August 18, 2015

The Global Health Implications of e-Cigarettes

Author Affiliations
  • 1Department of Medicine, Stanford University School of Medicine, Stanford, California
  • 2Center for Innovation in Global Health, Stanford University, Stanford, California
JAMA. 2015;314(7):663-664. doi:10.1001/jama.2015.8676

Few topics in tobacco control have been more hotly debated in the past several years than electronic cigarettes (e-cigarettes) or electronic nicotine delivery systems (ENDS). Advocates claim that the devices, which use battery power to aerosolize nicotine into a chemical propellant, offer significant harm reduction because they do not create the carcinogenic combustion products found in conventional paper cigarettes.1,2 Critics, meanwhile, point to a host of concerns regarding the unproven health claims and questionable advertising tactics by e-cigarette companies as reasons for greater regulation of these products. While health departments and researchers try to collect data on these issues, the use of ENDS has increased substantially globally, with a 2014 World Health Organization (WHO) survey suggesting that more than half the world’s population resides in countries where ENDS are available for purchase.3 The growing market was valued at an estimated US $3 billion in 2013, with projections estimated to reach $10 billion by 2017.3,4 The availability of ENDS extends not just to wealthy nations but also to low- and middle-income countries (LMICs) because the devices can now be made more inexpensively.